Syncope in Young Patients I: An Approach to the Patient with Syncope

yncope is among the most common causes of emergency department and outpatient clinic visits in the United States, accounting for 5% of such visits and 1% to 3% of all hospital admissions. 1 Despite a benign outcome in most cases, syncopal events can cause significant distress to patients and their families, especially when the patient is young and otherwise healthy. This article, which is the first part of a 2-part series, will review the necessary steps to determine the cause of syncope, especially in young persons. The importance of history taking, physical examination, and laboratory and other diagnostic testing will be stressed. Moreover, the implications of syncope in the specific population of children and young adults who are athletes or otherwise participate in sports will be discussed, as will the related issue of sudden cardiac death (SCD). INITIAL CLASSIFICATION Persons who experience syncope should have a basic work-up before undergoing more complicated, lowyield diagnostic studies. The key initial step should be to classify the syncopal episode as cardiac or noncardiac. 1